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Thangaraj Abiramalatha, DM; Viraraghavan Vadakkencherry Ramaswamy, DM; Tapas Bandyopadhyay, DM; Sanjana Hansoge Somanath, DM; Nasreen Banu Shaik, MD; Abdul Kareem Pullattayil, MiST; GaryM.Weiner,MD. Interventions to Prevent Bronchopulmonary Dysplasia in Preterm Neonate. An Umbrella Review of Systematic Reviews and Meta- analyses. JAMA Pediatrics. 2022 Feb 28

IMPORTANCE Bronchopulmonary dysplasia (BPD) has multifactorial etiology and long-term adverse consequences. An  umbrella review enables the evaluation of multiple proposed interventions for the prevention of BPD.

OBJECTIVE To summarize and assess the certainty of evidence of interventions proposed todecrease the risk of BPD
from published systematic reviews.

DATA SOURCES MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, andWeb of Science were searched  from inception until November 9, 2020.

STUDY SELECTION Meta-analyses of randomized clinical trials comparing interventions inpreterm neonates that
included BPD as an outcome.

DATA EXTRACTION AND SYNTHESIS Data extractionwas performed in duplicate. Quality ofsystematic reviews was
evaluated using Assessment of Multiple Systematic Reviews version2, and certainty of evidence was assessed using
Grading of Recommendation, Assessment, Development, and Evaluation.

MAIN OUTCOMES AND MEASURES (1) BPD or mortality at 36weeks’ postmenstrual age (PMA) and (2) BPD at 36
weeks’ PMA.

RESULTS A total of 154 systematic reviews evaluating 251 comparisons were included, of which 110 (71.4%) were
high-quality systematic reviews. High certainty of evidence from high-quality systematic reviews indicated that delivery room continuous positive airway pressure compared with intubation with or without routine surfactant
(relative risk [RR], 0.80 [95%CI, 0.68-0.94]), early selective surfactant compared with delayed selective surfactant (RR,  0.83 [95%CI, 0.75-0.91]), early inhaled corticosteroids (RR, 0.86 [95%CI, 0.75-0.99]), early systemic hydrocortisone (RR,  0.90 [95%CI, 0.82-0.99]), avoiding endotracheal tube placement with delivery room continuous positive airway
pressure and use of less invasive surfactant administration (RR, 0.90 [95%CI, 0.82-0.99]), and volume-targeted
compared with pressure-limited ventilation (RR, 0.73 [95%CI, 0.59-0.89]) were associated with decreased risk of BPD or mortality at 36 weeks PMA. Moderate to high certainty of evidence showed that inhaled nitric oxide, lower
saturation targets (85%-89%), and vitamin A supplementation are associated with decreased risk of BPD at 36 weeks
PMA but not the competing outcome of BPD or mortality, indicating theymay be associated with increased mortality.   CONCLUSIONS AND RELEVANCE A multipronged approach of delivery room continuous positive airway pressure, early  selective surfactant administration with less invasive surfactant administration, early hydrocortisone prophylaxis in
high-risk neonates, inhaled corticosteroids, and volume-targeted ventilation for preterm neonates requiring invasive  ventilation may decrease the combined risk of BPD or mortality at 36 weeks PMA.

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